For cancer patients, the end of treatment simply marks the beginning of the next phase of their journey. They are filled with uncertainties and anxieties as they await results from routinely scheduled imaging studies and follow-up visits. These uncertainties lead to stress that can hinder a patient’s ability to return to their normal life. Despite the available resources to help cancer patients, each patient has a unique journey that can be unpredictable, making it challenging to ease underlying concerns.
Current standard imaging modalities such as computerized tomography (CT) and positron emission tomography (PET) scans are some of the tools used to look for cancer recurrence. Although these tools have clinical utility, they also have limitations and are not 100% sensitive or specific. For the patient, this may mean additional testing and follow-up appointments, adding further uncertainty to an already uncertain time. However, with the continued evolution of precision medicine, there are now more tools than ever before available to help clinicians make decisions about how to best manage their patients’ care and how to guide the most appropriate next steps in their patients’ journey.
What are some of the recent scientific advancements in precision oncology?
As tumor cells die and break down, DNA from those cells is released into the bloodstream. The presence of this circulating tumor DNA (ctDNA) after definitive treatment is also known as molecular residual disease (MRD). MRD is detected in blood samples using next-generation sequencing, and detected MRD is evidence that cancerous cells may be present in the body. In the case of patients who are being monitored for recurrence, this could mean the cancer was not fully eliminated or has returned after treatment. Therefore, two of the goals of MRD testing are to empower the patient and clinician to understand where the patient is along their care journey and to inform the next steps in management.
What is the potential value of MRD testing?
MRD testing complements current imaging modalities and together, along with clinical judgment, these tools may be used to monitor for recurrence. As recent data suggest, MRD testing may indicate recurrence of disease prior to evidence of recurrence by imaging studies and may allow for proactive disease management with additional lead time. By providing a minimally invasive method to further investigate cancer recurrence, MRD testing may also help alleviate some of the concerns many patients have around recurrence monitoring. The benefits of MRD testing may also extend to the healthcare system. Overall, the use of ctDNA-based MRD analysis may provide support for clinical decision making as well as improve survival outcomes for patients in the era of precision medicine. Valuable lessons have been learned from screening that help reinforce the clinician’s responsibility to investigate for recurrence using the most advanced technology.
What seems to be the trend in the space when it comes to providing this type of test in a clinical setting?
MRD testing may have value throughout the cancer journey, with potential applications in adjuvant therapy determinations, monitoring treatment response and assessing for recurrence. Challenges will always arise with the adoption of innovative technologies, but those challenges do not diminish the obligation of healthcare systems to provide the highest level of care to their patients. Healthcare organizations could benefit from tools such as an MRD test that could help guide clinicians when making treatment plans and to provide answers to some of the big questions that plague cancer patients, such as “Did my cancer respond to therapy?” “Do I still have cancer?” “Has my cancer returned?”
Snehal Thakkar, MD, is senior director, Medical Affairs, Therapy Selection, Exact Sciences, Madison, Wis.
A Premier Corporate Partner of ACHE, Exact Sciences is guided by the mission to eradicate cancer and the suffering it causes—through tests that help prevent it, detection that finds it earlier and guidance for successful treatment. For more information, visit ache.org/ExactSciences.